The Danforth killer led a life of “struggle and pain,” Faisal Hussain’s devastated family says — a history of psychosis and depression no drugs or psychiatric therapy could reach.

These kind of explanations may be easier for the public to accept, experts writing in the 2016 book Gun Violence and Mental Illness say. Who but a madman — and mass murderers are almost exclusively male — would deliberately and methodically set out to kill as many people as he could as he strolled through Toronto’s Greektown?

The motivations behind Sunday night’s rampage that left 18-year-old Reese Fallon and a 10-year-old child dead are still unknown. We’re still very much flying blind, experts say. But how much of a role does mental illness play in mass murder, and could more have been done to stop Hussain?

Many mass shooters have struggled with depression and, more rarely, psychosis. However, the vast majority of people with serious mental illness are not violent, don’t harbour any major anger or resentment and don’t pose a danger to others, said Dr. Sidney Kennedy, director of the Centre for Depression and Suicide Studies at Toronto’s St. Michael’s Hospital.

With psychosis does come hallucinations and delusional beliefs. People hear voices, see things or objects that aren’t there, even hallucinate tastes or smells.

The delusional beliefs — ‘I was sent by a force to carry out a mission’ — have no basis in reality “but are held by an individual in a fixed, kind of unshakable way,” Kennedy said.

Anti-depressants and psychological treatments like cognitive behavioural therapy are standard treatments for depression. But add the layer of psychotic symptoms and more is needed, like anti-psychotics or even electroconvulsive (shock) therapy.

However, “mental health treatment is not always a guaranteed cure, and it’s neither humane nor feasible to simply lock up everyone who is struggling with serious mental health problems,” said criminologist Adam Lankford.

Toronto police sources told the National Post that there had been “very little” contact with Hussain under the province’s Mental Health Act. Under the act, a person has to be assessed within 72 hours and “it’s very difficult unless there is very clear evidence (of potential violence) to hold an individual against his or her will,” Kennedy said.

According to the statement by the Hussain family, “the interventions of professionals were unsuccessful. Medications and therapies were unable to treat him.” Left unanswered: if Hussain, who, according to witnesses, gunned down people execution-style, was under the care of a psychiatrist, how did he get access to a gun? And how did a mental health professional miss his dangerousness?

Toronto Danforth shooter Faisal Hussain.Hussain family/AP

“There are certainly examples where individuals hid psychotic beliefs, psychotic features,” Kennedy said, and it’s only in the aftermath their delusional writings are discovered.

Adam Lanza, who killed 20 first-graders and six teachers at Sandy Hook Elementary School in Newton, Connecticut in 2012, had not left his room for three months before the massacre. He taped his bedroom windows over with black plastic garbage bags. According to CNN, in an email three days before his attack at his former school, Lanza wrote in an online cyber community of mass murder enthusiasts: “The inexplicable mystery to me isn’t how there are massacres, but rather how there aren’t 100,000 of them every year.”

One of the words used by people who study mass murderers is “leakage” — the mass shooter essentially saying something that signals his or her intent, Lankford said.

“Did this perpetrator tell someone he had an interest in this?”

Forty-percent of mass murderers die, either by suicide or killed by police.

In 1999, 12th graders and spree killers Eric Harris and Dylan Klebold killed 13 people and wounded 24 others in the Columbine High School massacre. The killers killed themselves in the library, where they had massacred 10 of their victims.

“By most accounts Eric was the kind of ringleader, and a budding psychopath,” said University of Toronto associate professor of sociology Jooyoung Lee, who taught a summer course on mass shootings.

“Dylan suffered from chronic depression and saw the mass shooting as a farewell to the world and as a way to kill himself.”

There are certainly examples where individuals hid psychotic beliefs

In most cases of mass shooters, there is a profound sense of resentment and hatred for the world, Lee and others said. Most use a gun for maximum kill.

Neighbours and acquaintances said Hussain was a quiet, shy and reserved guy with a “million-dollar smile” who didn’t have a lot of friends, and who sometimes said “inappropriate things.” Mass shooters (technically defined as those who kill four or more people) are typically loners.

Memorial University anthropologist Elliott Leyton, author of Hunting Humans: The Rise of the Multiple Modern Murderer said he has “very little confidence” in the mental illness theory as applied to mass killings.

“Friends of mine, who I respect, say I don’t have enough sympathy for disturbed people who wreak havoc. And I’m sure they’re right,” Leyton said. “But it’s hard for me not to have those feelings.”

“For every one of me there are 500 people who say, ‘oh, it’s the total explanation.’ Maybe they’re right. I don’t know. But I tried to argue mental illness was not a very satisfactory explanation for this kind of thing and all it does is stigmatize the mentally ill.”

Video screenshot of the suspected gunman, later identified as Faisal Hussain, who opened fire in Toronto’s Greektown.@arilanise/Instagram

In his research — and he has studied hundreds of multiple and mass killers — he found very little sign of mental illness as being of “fundamental importance.”

Instead, he said, it’s more about people who have “an incredible grudge against a particular group, or community. And after thinking about it for a long time decide to do something that would relieve the tension on themselves.

“So they go charging off and start shooting, or stabbing.”

What we risk missing is other social factors that may play a much more profound role than mental disturbance, Leyton said, “like their position in society and their relationship with their own families.”

Hussain’s sister died several years ago in an accident.

In the U.S. someone with a history of depression and even psychosis could still legally purchase a gun, provided he or she hasn’t been hospitalized in a psychiatric ward “or been adjudicated as mentally defective,” Lankford said, even if the person has made violent threats.

If Hussain got his gun legally, “that really raises questions about the robustness of the background checks system,” Lee said.

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